A severe neurological event during a local anaesthesia phlebectomy

A 58 year old female patient underwent an intervention of phlebectomy below the knee. The patient gradually developed a severe neurological event and the Glasgow Coma Score decreased dramatically. After two and a half hours from onset, general conditions gradually improved and recovered completely. Lidocaine neurotoxicity was excluded. A right side motor deficit strongly suggests a transient ischaemic attack. As to invasivity, phlebectomy can be compared with liquid and foam sclerotherapy so that the simple question arises of also comparing their adverse effects. We have the strong conviction that this case may only be a co-incidental association.</jats:p

Foam sclerotherapy: cardiac and cerebral monitoring

Objectives To investigate and review collected and reported transcutaneous ultrasound, transthoracic echocardiography (TTE) and transcranial Doppler (TCD) data obtained during ultrasound-guided foam sclerotherapy (USGFS) of incompetent saphenous, tributary and perforating veins of the lower extremities. Methods TTE and/or middle cerebral artery TCD were performed during USGFS. Ultrasound (US) findings and adverse events were recorded. Existing literature was reviewed. Results Ultrasound detected emboli circulating in superficial, perforating, communicating and deep veins and into the central circulation. TTE detected bright echoes in the right heart after every injection and in the left heart in up to 65% of selected patients. TCD high-intensity transient signals (HITS) were detected in 14–42% of the patients. Incidence of HITS was higher than patient reports of adverse events. Incidence of HITS was independent of foam volumes injected. Conclusion Echogenic signals were detected in non-treated veins, in heart chambers and in the cerebral circulation by transcutaneous US, TTE and TCD. Pathological consequences of such findings remain to be investigated. </jats:sec

An Empirical Model for Automobile Driver Horizontal Curve Negotiation

Continuous recordings of test drivers on rural horizontal curves indicated that test drivers exhibited a non-linear relation in velocity and lateral acceleration at the point of maximum acceleration. A model is proposed which includes a driver aspiration velocity, maximum lateral acceleration tolerance, and an expedience parameter related to the driver's willingness to trade velocity for lateral acceleration. The model provides a good fit to different types of data which include: (1) “relaxed” drive vs. “late for appointment” scenarios; and (2) familiarity of roadway. The empirical models indicate changes in the expedience parameter and aspiration velocity. </jats:p

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

Objectives: Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods: Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results: At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) (P=ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes (p&lt;0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) (p&lt;0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions: Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk

Upper limb secondary lymphedema ultrasound mapping and characterization

Background: Ultrasound investigation potentials in lymphedema are still to be fully used in everyday practice. Aim of the present study was to report the sonographic characterization of the dermo-epidermal complex (DEC) and of the subcutaneous (SUBC) tissue, assessing the feasibility of a related mapping, in upper limb secondary lymphedema. Methods: In this retrospective study 287 patients affected by monolateral upper limb post-mastectomy lymphedema (M5/F282; mean age 64±4.24) were enrolled and scanned by ultrasound, considering the healthy contralateral limb as control. In order to standardize the assessment, the limb was divided in sectors: 4 anterior, 4 posterior below the elbow, 4 anterior and 4 posterior above the elbow, plus the hand. DEC and SUBC regions B-mode appearance were reported, both in the healthy and in the pathological arms. DEC thickness was measured and compared among the same sectors of the healthy and pathological limbs. Results: DEC and SUBC sonographic appearance was differentiated in fluid and sclerotic. DEC included a third category characterized by differentiation loss. The different sectors showed significantly different lymphatic involvement in the affected limb. In the comparison with the contralateral unaffected segments a significantly thicker DEC was reported in the forearm affected by lymphedema (P&lt;0.005), while no significant difference was reported at the arm level. Conclusions: Traditional ultrasonography can provide a secondary upper limb lymphedema characterization with related mapping and useful data for a better lymphatic physiopathology understanding and for a properly addressed therapeutic protocol